title: Prognostic factors associated with radiotherapy for cervical cancer with computed tomography-detected para-aortic lymph node metastasis.
abstract: Patients with cervical cancer diagnosed with a para-aortic lymph node (PALN) metastasis by computed tomography (CT) scan were analyzed to identify associated prognostic factors. A total of 55 patients were reviewed, and 27 of these patients underwent extended-field radiotherapy (EFRT). The median PALN dose in patients receiving EFRT was 45 Gy (range, 27-57.6 Gy). Of the 55 patients, 28 underwent pelvic radiotherapy (RT); concurrent chemoradiotherapy (CCRT) was administered to 41 patients. The Kaplan-Meier method was used to calculate the actuarial rate. Multivariate analysis was performed using the Cox proportional hazards model. Five-year overall survival (OS) rates were 41% and 17.9% in patients undergoing EFRT and pelvic RT (P = 0.030), respectively. Age < 53 years (P = 0.023), FIGO Stage I-II (P = 0.002), and treatment with EFRT (P = 0.003) were independent predictors of better OS. The use of CCRT (P = 0.014), Stage I-II (P = 0.002), and treatment using EFRT (P = 0.036) were independent predictors of distant metastasis. In patients undergoing EFRT plus CCRT, the 5-year OS was 50%. Three-year PALN disease-free rates were 8.8%, 57.9% and 100% (P < 0.001) in CCRT patients who received PALN doses of 0 Gy, ≤45 Gy and ≥50.4 Gy, respectively. Although PALN metastasis is thought to be distant metastasis in cervical cancer, EFRT plus CCRT shows a good outcome, particularly in younger patients in an early FIGO stage. Cervical cancer with a PALN metastasis should not be considered incurable. Doses ≥50.4 Gy for treating PALN may result in better disease control.
authors.affiliation: Department of Radiation Oncology, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Wu
authors.forename: Eng-Yen
authors.initials: EY
authors.lastname: Huang
authors.forename: Chan-Chao
authors.initials: CC
authors.lastname: Chanchien
authors.forename: Hao
authors.initials: H
authors.lastname: Lin
authors.forename: Chong-Jong
authors.initials: CJ
authors.lastname: Wang
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Sun
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Fu-Min
authors.initials: FM
authors.lastname: Fang
authors.forename: Hsuan-Chih
authors.initials: HC
authors.lastname: Hsu
authors.forename: Yu-Jie
authors.initials: YJ
authors.lastname: Huang
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001027:Aortography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*
keywords: cervical cancer; concurrent chemoradiotherapy; extended-field; para-aortic lymph node; prognostic factors